确定在外科护理中的人口层面和医院内部差异
Elzerie de Jager1,2,3, Samia Y Osman2,4, Christina Sheu2
1From the Division of Public Health, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT (de Jager).
Journal of the American College of Surgeons
|May 9, 2024
概括
在风险调整后,很少有医院表现出显著的外科手术护理差异. 不平等往往与地区剥夺有关,而不是种族或种族,这表明需要检查访问和隔离.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善外科手术的质量
- 健康 公平 卫生 公平
背景情况:
- 缺乏关于公平性衡量的共识,阻碍了解决外科护理方面的差异.
- 医院和系统级质量评估计划可能没有充分纳入公平.
- 这项研究解决了需要确定在外科护理质量方面在人口层面和医院内部的差异的需求.
研究的目的:
- 确定在手术护理质量方面在人口层面的差异.
- 发现医院内在手术护理质量的差异.
- 通过区域贫困指数 (ADI),种族和种族来分析差异.
主要方法:
- 来自国家外科质量改进计划 (NSQIP) 数据库 (2014-2018) 的657家医院和400多万患者的分析.
- 利用多层随机斜率,随机截取模型来评估人口层面和医院内差异.
- 检查了5个质量指标:死亡率,再接收,手术部位感染,切除术死亡率和脊柱手术并发症.
主要成果:
- 在ADI的所有措施中发现了人口层面的差异,在黑人种族方面,在2个措施中发现了差异 (重新录取,脊柱手术并发症).
- 在西班牙裔族群中没有发现人口层面的差异.
- 经过风险调整后,只有不到1.1%的医院在医院内有显著的ADI,种族或种族差异.
结论:
- 在风险调整后,在外科护理方面在医院内显著的差异很少出现.
- 与种族和种族相比,ADI更频繁地确定了差异.
- 检测到的医院内差异有限的潜在原因包括术后指标,样本大小和风险调整方法;需要进一步研究准入和隔离.
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